Acute Health Challenges- The Surgical Experience Flashcards
Define Surgery.
the art and science of treating diseases injuries and deformities by operation & instrumentation
Name 3 phases of preoperative period.
pre-operative
intra-operative
post operative
Reasons for surgery.
dx cure palliation prevention exploration cosmetic
Elective surgery.
planned surgery
Emergency surgery.
unexpected or urgent
Where are surgeries performed?
- OR with admission
- Same day admission (ambulatory surgery/outpt) -discharged home after
- Dr.’s office
- ER
- Clinics
5 expected outcomes of surgical intervention.
- Dx
- Reconstructive
- Curative
- Palliative
- Transplant
Diagnostic surgery.
(biopsy) origins of symptoms & extent of disease
Reconstructive surgery.
correct disease or improve cosmetic appearance
Curative Surgery.
repair or remove disease organ- restore normal function (e.g. amputation, aneurysm)
Palliative Surgery.
decrease spread of disease and prolong life- alleviate pain
Transplant Surgery.
remove organ replace with functioning one
Preoperative nursing role.
- Co-ordinate client care
- Ensure pre-operative tests are WNR
- Varify documents (go through pre op checklist)
- Report abnormalities
- Major responsibility is teaching in preparation for OR
Pre-op Surgeon Responsibilities.
- Determine need for surgery: Pre-op assessment, determine surgical setting in collaboration with the client, diagnostic tests that directly correlate with the OR and Dx
- Consent for surgery
- Teaches client about outcomes and risk of OR
- Ensures client safety in OR
- Post-op management
When does the hx and physical done and by whom?
30 days before surgery by family physician
Anesthetist responsibilities.
- consent for anesthesia
- pre op evaluation (hx, complications from previous anesthesia, medications, OTC, Herbal, advise when to D\C meds prior to OR)
- select anesthetic agents
- teacher re: anesthetic medications and side effects and risk factors
- intubation and extubation
- monitors throughout OR
Nurses responsibilities re: consent for surgery.
- must advocate on the pts behalf if additional info is requested
- consent must be signed prior to the administration of pre-op medications
Who’s responsibility is it to get consent for surgery.
the physician
Conditions for informed consent.
- adequate disclosure
- demonstration clear understanding and comprehension of the information being provided
- consent must be voluntarily
Assessment in the preoperative phase- Nursing Hx includes.
- factors that can increase risk or influence outcomes
- medical hx including family hx of anesthesia problems (malignant hyperthermia, etc)
- medication allergies, other allergies
- age related factors
- social/cultural/spiritual concerns (ex. blood transfusions for Jehovah Witness)
- psychological status (assess fears)
- 3rd person help with language/mental status if a needed
Components of psychological assessment of the pt before surgery.
SITUATIONAL CHANGES
- support system
- personal control, decision making, and independence
- impact of surgery on family and dependents, finance, etc.
- hope and anticipation of positive results
CONCERNS WITH THE UNKNOWN
- identify specific areas and depth of anxiety and fear
- identify expectations of surgery, changes in current health status, & effects on daily living
CONCERNS WITH BODY IMAGE
- current roles or view of self
- perceived or potential changes in role or relationships and their impact on body image
PAST EXPERIENCES
- review previous surgical experiences, hospitalizations and txt (positive or negative)
- current perception of surgery in re: to the above
KNOWLEDGE DEFICIT
- Identify what amount and type of preoperative information this specific pt wants to receive
- assess understanding
- identify accuracy in info
Subjective health hx data of pt about to undergo surgery.
PAST HEALTH HX
- past surgery? which one? complications?
- family hx of surgical complications?
- past hospitalizations?
- chronic health conditions?
- HTN? Cardiac disease?
- Hx of dyspnea, coughing, hemoptysis, COPD or asthma
CURRENT HEALTH HX
- usual or present height and weight? Recent weight loss or gain?
- present respiratory tract infection?
- do you wear glasses, contact lenses, or hearing aids?\
- Do you smoke? How many packs/day? How many years?
- Alcohol intake?
- problems healing?
- musculoskeletal problems that might affect positioning during surgery or activity level after surgery?
- limitation in mobility o your neck?
- equipment for ambulation?
- pain tolerance? methods used for pain relief?
- anxiety r/t surgery?
- support following discharge?
MEDICATIONS
- prescribed? OTC? herbal?
- allergies, or sensitivities to food or meds?
Considerations for the older adult.
- normal aging decreased immune system
- delayed wound healing
- decreased ability to withstand stress
- changes in mental status
- increased incidence of chronic disease
- increased cardiac pulmonary complications
Medical hx.
- previous admissions/ OR
- past illnesses
- reason for surgery
- complications previous OR
- prior blood transfusion or reactions
- objections to getting blood
- Medications (prescribed, OTC/herbal, ASA stopped 2 weeks prior to OR)
